Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SUPPORT FOOT UNIVERSL 82652000

Facility

$845.00

Hospital Charge Code	270643408
Hospital Revenue Code	272
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$126.75
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

SUPPORT L-S

Facility

$716.00

Hospital Charge Code	270606573
Hospital Revenue Code	270
Min. Negotiated Rate	$17.26
Max. Negotiated Rate	$358.00
Rate for Payer: Aetna Commercial	$272.08
Rate for Payer: Aetna Medicare Advantage	$214.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$182.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$182.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$182.58
Rate for Payer: Cigna Commercial	$358.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.80
Rate for Payer: Oxford Commercial	$143.20
Rate for Payer: Qualcare PPO/HMO/WC	$107.40
Rate for Payer: UnitedHealthcare Commercial	$143.20
Rate for Payer: UnitedHealthcare Community & State	$17.26
Rate for Payer: Wellpoint Medicaid Managed Care	$18.97

SUPPORT L-S

Facility

$716.00

Hospital Charge Code	270606573
Hospital Revenue Code	270
Min. Negotiated Rate	$107.40
Max. Negotiated Rate	$107.40
Rate for Payer: Qualcare PPO/HMO/WC	$107.40

SUPPORTOR A-3 LG ELAST

Facility

$27.10

Hospital Charge Code	270303080
Hospital Revenue Code	272
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.55
Rate for Payer: Aetna Commercial	$10.30
Rate for Payer: Aetna Medicare Advantage	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.91
Rate for Payer: Cigna Commercial	$13.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.13
Rate for Payer: Oxford Commercial	$5.42
Rate for Payer: Qualcare PPO/HMO/WC	$4.07
Rate for Payer: UnitedHealthcare Commercial	$5.42
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

SUPPORTOR A-3 LG ELAST

Facility

$27.10

Hospital Charge Code	270303080
Hospital Revenue Code	272
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$4.07
Rate for Payer: Qualcare PPO/HMO/WC	$4.07

SUPPORTOR A-3 MED ELAST

Facility

$27.05

Hospital Charge Code	270303075
Hospital Revenue Code	272
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.53
Rate for Payer: Aetna Commercial	$10.28
Rate for Payer: Aetna Medicare Advantage	$8.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.90
Rate for Payer: Cigna Commercial	$13.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.12
Rate for Payer: Oxford Commercial	$5.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.06
Rate for Payer: UnitedHealthcare Commercial	$5.41
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

SUPPORTOR A-3 MED ELAST

Facility

$27.05

Hospital Charge Code	270303075
Hospital Revenue Code	272
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$4.06
Rate for Payer: Qualcare PPO/HMO/WC	$4.06

SUPPORT RING 180 49630118

Facility

$4,765.00

Hospital Charge Code	270643411
Hospital Revenue Code	272
Min. Negotiated Rate	$714.75
Max. Negotiated Rate	$714.75
Rate for Payer: Qualcare PPO/HMO/WC	$714.75

SUPPORT RING 180 49630118

Facility

$4,765.00

Hospital Charge Code	270643411
Hospital Revenue Code	272
Min. Negotiated Rate	$114.84
Max. Negotiated Rate	$2,382.50
Rate for Payer: Aetna Commercial	$1,810.70
Rate for Payer: Aetna Medicare Advantage	$1,429.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,215.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,215.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,215.08
Rate for Payer: Cigna Commercial	$2,382.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,429.50
Rate for Payer: Oxford Commercial	$953.00
Rate for Payer: Qualcare PPO/HMO/WC	$714.75
Rate for Payer: UnitedHealthcare Commercial	$953.00
Rate for Payer: UnitedHealthcare Community & State	$114.84
Rate for Payer: Wellpoint Medicaid Managed Care	$126.27

SUPPORT SCROTUM XL NVC

Facility

$36.00

Hospital Charge Code	270624861
Hospital Revenue Code	270
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

SUPPORT SCROTUM XL NVC

Facility

$36.00

Hospital Charge Code	270624861
Hospital Revenue Code	270
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Oxford Commercial	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$7.20
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

SUPPORT TUBE

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270703248
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

SUPPORT TUBE

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270703248
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

SUPPORT WRIST COMFORT MED LEFT

Facility

$27.65

Hospital Charge Code	270653967
Hospital Revenue Code	270
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$4.15
Rate for Payer: Qualcare PPO/HMO/WC	$4.15

SUPPORT WRIST COMFORT MED LEFT

Facility

$27.65

Hospital Charge Code	270653967
Hospital Revenue Code	270
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$13.82
Rate for Payer: Aetna Commercial	$10.51
Rate for Payer: Aetna Medicare Advantage	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.05
Rate for Payer: Cigna Commercial	$13.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.29
Rate for Payer: Oxford Commercial	$5.53
Rate for Payer: Qualcare PPO/HMO/WC	$4.15
Rate for Payer: UnitedHealthcare Commercial	$5.53
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

SUPRA ENTRY GUIDEWIRE 3.0MM

Facility

$687.50

Hospital Charge Code	270703325
Hospital Revenue Code	272
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$343.75
Rate for Payer: Aetna Commercial	$261.25
Rate for Payer: Aetna Medicare Advantage	$206.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.31
Rate for Payer: Cigna Commercial	$343.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.25
Rate for Payer: Oxford Commercial	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$103.12
Rate for Payer: UnitedHealthcare Commercial	$137.50
Rate for Payer: UnitedHealthcare Community & State	$16.57
Rate for Payer: Wellpoint Medicaid Managed Care	$18.22

SUPRA ENTRY GUIDEWIRE 3.0MM

Facility

$687.50

Hospital Charge Code	270703325
Hospital Revenue Code	272
Min. Negotiated Rate	$103.12
Max. Negotiated Rate	$103.12
Rate for Payer: Qualcare PPO/HMO/WC	$103.12

SUPRAFOIL SMOOTH NYLON 4CMX4CM

Facility

$38.75

Hospital Charge Code	270640738
Hospital Revenue Code	270
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$19.38
Rate for Payer: Aetna Commercial	$14.72
Rate for Payer: Aetna Medicare Advantage	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.88
Rate for Payer: Cigna Commercial	$19.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.62
Rate for Payer: Oxford Commercial	$7.75
Rate for Payer: Qualcare PPO/HMO/WC	$5.81
Rate for Payer: UnitedHealthcare Commercial	$7.75
Rate for Payer: UnitedHealthcare Community & State	$0.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

SUPRAFOIL SMOOTH NYLON 4CMX4CM

Facility

$38.75

Hospital Charge Code	270640738
Hospital Revenue Code	270
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$5.81
Rate for Payer: Qualcare PPO/HMO/WC	$5.81

SUPRAX/100MG/5ML 100ML

Facility

$276.00

Hospital Charge Code	60634912
Hospital Revenue Code	250
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.40

SUPRAX/100MG/5ML 100ML

Facility

$276.00

Hospital Charge Code	60634912
Hospital Revenue Code	250
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$138.00
Rate for Payer: Aetna Commercial	$104.88
Rate for Payer: Aetna Medicare Advantage	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.38
Rate for Payer: Cigna Commercial	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.80
Rate for Payer: Oxford Commercial	$55.20
Rate for Payer: Qualcare PPO/HMO/WC	$41.40
Rate for Payer: UnitedHealthcare Commercial	$55.20
Rate for Payer: UnitedHealthcare Community & State	$6.65
Rate for Payer: Wellpoint Medicaid Managed Care	$7.31

SUPRAX/400MG/CAP

Facility

$28.00

Hospital Charge Code	60634914
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

SUPRAX/400MG/CAP

Facility

$28.00

Hospital Charge Code	60634914
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

SUPVJ HANDLING LOADING

Facility

$200.00

Service Code	HCPCS 77790
Hospital Charge Code	85000880
Hospital Revenue Code	342
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

SUPVJ HANDLING LOADING

Facility

$200.00

Service Code	HCPCS 77790
Hospital Charge Code	85000880
Hospital Revenue Code	342
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$5,021.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$118.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.00
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

Know your out-of-pocket cost for care.

All Charges